Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.

Monday, February 11, 2008

In Treatment: Episode 11....the sub-blog

Mike Huckabee was on Meet The Press discussing how he cooked squirrel in a popcorn popper in his college dorm. That is so weird.

Okay, back to our show here:Paul is sleeping on the couch in his office, fully dressed, rudely awakened by the alarm. His idea or Kate's?

Laura is 25 minutes late, she asks for water (also a common theme on this show, no wonder they all have to go to the bathroom). She's come in a cab and she watched a dog get hit by cars, repeatedly. "I had to get him to a vet. You would have pulled over?" Paul responds, "I wouldn't have pulled over, I'd have assumed he was dead and there was nothing I could do."

He points out that she would have been late, dead dog or not, "I would have appreciated a call." She accuses him of being "anti-me."

"What do you think your being late is trying to say to me? Maybe you think I'm not doing my job?" "Are you angry with me? Maybe we need to talk about what good this therapy is doing you." She talks about her distress at the end of the last session. "You're trying to make me angry. I can't win here." She curses him out. "You don't have to love me in return."

"Now I see why they laugh at shrinks and their ridiculous interpretation." She talks about her helplessness as the patient, about having an idiotic theory thrust on her.

"Maybe I'm not helping you at all," Paul says.

They talk about Laura's upcoming marriage, how she hasn't told her father, though her husband-to-be has blasted his whole e-addressbook. He returns her to the issue of her being late.

"You want to kick me out of therapy." He says absolutely not, but then says they should think about winding down. "You don't want me to treat you as a psychologist (he really garbles this, did he say ologist or iatrist?)....I'm the one who says No, who humiliates you. Therapy should not be a source of constant humiliation for you."

"Am I the first patient to be in love with you, Paul? Maybe you can't treat me because you're in love with me Paul?" She's breached the boundaries. He ends the session despite her pleas for more time and Laura storms off while Paul tries to hand her the bill. Laura bumps into Alex, who has arrived for his session a day early. They flirt on the street and they drive off together.

Oh my, so we've got early patients, late patients, popping squirrels and dead dogs. Patients in love with shrinks ramming unwelcome theories at them, and an uncomfortable doc who wants the patient to leave.

Okay, so I still don't know What Paul is. Laura made a reference to med school, so I thought a psychiatrist, but there's never any mention of meds. Of course, with all that water, one might think everyone has dry mouth from their medications. One of our commenters has said he's a psychoanalyst, but I don't think so, his patients come weekly, not daily, and he doesn't have an analytic set up with a chair behind an analytic couch (these are rather specific couches).Paul and Laura have a discussion that epitomizes the type of power struggle our commenters often worry about. Another episode where no one feels heard. You know, the whole point of psychotherapy (or at least one major point of psychotherapy) is to feel heard. These people are getting it all wrong, and I don't blame Laura for feeling cornered. Seems like Paul takes turns with his patients being painted against the wall.

Why can't Paul be honest? It's hard to have a patient declare that they're in love with you, the boundaries are a mess, he's feeling uncomfortable and he CAN'T have a relationship with her, it's simply unethical and he would lose his license. So he went to see an old supervisor, to get another opinion of how to handle a situation that's uncomfortable for him and that is obviously uncomfortable and painful for her. The supervisor wondered if they shouldn't consider transferring her care and he feels that now that that option's been brought up, they should look at it. Laura would be mad, she'd feel betrayed, but at least it's honest, it gives the sense of consultation and propriety, and instead he's pushing Laura away, treating her unfairly, being unnecessarily cold.

And a final thought here-- Sarebear asked if anyone here worries about being sued (I think it was Sarebear)--between making tea and having one's wife dress one's patient in their daughter's dry clothes. Really, there's nothing to be sued for here--- there are only a few boundaries that are set in stone (don't sleep with your patient and don't kill them, for starters). A patient could lodge a complaint that her therapist made her tea, but why? And since he makes tea for everyone, and the question is milk or sugar, not Red or White, there isn't a boundary violation. And giving an injured wet and cold young patient dry clothes, well, it's hard to find harm here. The boundary issues become salient if a patient ends feeling injured, and then the doctor's behavior gets scrutinized. If Laura feels jilted, and she sues Paul, then things like whether he extended the time of the sessions, what he gave her to drink, whether they'd ever met outside of the office, then and only then is it an act that has relevance. Even if a patient and a therapist were to go out for a meal, yes this is a boundary violation, but in the absence of something more, a patient can't sue a doctor simply for going out to eat a meal. It's just a suspect thing to do, and becomes a part of the case against the doctor, if the patient then alleges they had sex.ClinkShrink, I hear, shares her squirrels with her inmates.

19 comments:

I thought I heard Paul refer to himself as a psychologist in this episode.

Also, I was glad when he didn't extend her time after she showed up late. That would have been a bad move and given her a lot of power.

I liked Paul more in this episode, but Laura less. She takes things too personally and tries to turn things back around on Paul. It's HER therapy, not his. She's got power issues, I think. Maybe it's because she is also a doc.

I think he can handle her, especially if she continues to behave more erratically (like, hooking up with Tuesday's guy). Maybe she'll find someone else to abuse. That's what it seems like she was doing to Paul this time. (To me, anyway...who had the comment about our reactions to the show being a form of transference?)

Although I think Laura's question of whether or not Paul could handle her feelings was probably a litte aggressive, how do you approach that topic?

If the dr. is rather newly licensed and the patient was reassurance that venturing into transference waters will be safe---what's the protocol for asking about how the dr. feels about his ability to remain non-physical?

On the other hand, placing all of the responsibility on the doc to maintain boundaries seems a little immature and ...irresponsible?

good thoughts. I don't know that the issue of Laura being "in love" with Paul is transference. How could one prove that and what would it matter?

This is always uncomfortable stuff for a therapist.

The bottom line with regard to a patient-doctor sexual relationship is that the responsibility to stop this belongs completely to the doctor. The doctor can end a relationship if he feels threatened, but if they have sex, it's the doctor's transgression and any way you dice it, he's taken advantage of a patient. It doesn't matter if she was the instigator. The only other scenario I can think of is if a male patient forceably rapes a female doctor, and then it's simply thought of as a criminal felony, not something as muted as a "boundary violation."

Paul and Laura are now both behaving badly-- she needs a new and female psychiatrist.

Sort of nuts that I have such strong opinions about fictional characters.

No I don’t think it’s nuts that you have such strong feelings about fictional characters. Whatever you want to call it, TV viewer transference or otherwise, it is simply the hallmark of good television – series that are engaging and draw the viewer in so that the characters and their story arcs matter.

Actually if she'll quit pushing the love thing, I think Paul could help her if she'll talk more about her dad and why she doesn't want to tell him, and that stuff. I DO think she hit the nail on the head, realizing that Paul is shoving her away because of his own feelings, but I "think" she knows he's not going to get with her, either. He's made that clear.

Actually, since I'm pretty sure she has her confirmation of his feelings for her, she has power over him, in a way.

You should see the look on Paul's face tomorrow.

I guessed that it was Paul's decision to sleep where he did, although no doubt neither were comfortable sleeping together after last week's revelations. I think that Paul would not make a woman sleep on the couch. He can treat her like a woman in that abstract way, anyway, maybe.

I did like Laura's quip? about, so you're going to punish me now? as she held up the belt . . . lol!

Paul may not be taking the best course of action, but at least he's trying to "do" something about the situation. I feel that's a step or three up from sitting there for a year, being aware of her feelings, and his for her. He as much as admitted it when he was talking about therapy not being therapy for her, but it's been him humiliating her for a year knowing her feelings.

Not quite like that, but it was a tacit admission that he HAD picked up on her feelings a long time ago.

So, he's trying to do something about it, even if it's not the ideal, I am pleased that he's trying to, in the midst of his turbulent feelings regarding his wife, and regarding Laura, etc.

Actually, the worried about being sued thing, was because ANY parent nowadays, who has any occasion to be in proximity to someone else's child, naked or nearly so, is a potential lawsuit. Doesn't really have much to do with him being an ologist/iatrist. I heard ologist too; does that make you have less interest in the show?

HBO's mini-bio (http://www.hbo.com/intreatment/friday/) for Paul calls him a psychoanalyst. I heard "psychologist" in this episode, but I also heard the word "psychaitrist" (or maybe it was "psychaitry") in Sophie's episode from last week.

The "In Treatment" website said he was a psychoanalyst. I too am confused as to whether he is a psychiatrist or psychologist. I caught Laura's med school comment also, but, yes, there are never any Rxs doled out.

I love your comment about everyone's mouth being dry! So, so true.

I've never had a psychiatrist pour me a glass of water or make me tea. What a charming gesture!

Anyway, the website for "In Treatment" has some good info. check it out.

When I picture you in a tiara a want to call you Princess Dinah.

I thought you practiced out of your home for some reason...

I do not believe that Paul can effectively work with Laura. It is apparent that he does have feelings for her. I think it is lust and his situation with Kate just turns him into kindling that'll go up with the smallest spark.

I was admiring Laura's face last night and wondered if her lips were that lush in real life or if she had collagen. Also, I wondered if that was her hair or extensions. I mean, didn't she have auburn hair last week? Now it's brown.

Laura is incredibly hot and I think that she thinks that getting it on with Alex will hurt Paul or at least cause problems for him and that is the only reason she is doing it.

I would consider this behavior on her part as dangerous. Laura shouldn't allow herself to be picked up by a stranger.

I don't have a sink, it's all I can do to get water to the poor plants.I do have a small fridge inside a closet, so if someone is choking or in distress, I've given them a bottle of water.

Look what happened when Tony Soprano had an affair with Gloria, another patient of Dr. Melfi: Gloria committed suicide. Oh, yeah, that was fiction.

I had a psychiatrist friend who seriously dated a man she met in her analyst's waiting room (another patient). No one died, the relationship lasted years, but they didn't marry.

Finally, I wrote a novel about two patients of the same psychiatrist who fall in love...only they don't know they see the same psychiatrist and it takes a really long time until even the shrink figures out he's hearing the same story from two sides. And he's the one who gets cured from their psychotherapies. Any agents out there? It's meant for easy conversion to a movie.

And sometimes sex with a stranger is exactly what you need to get an STD or much worse. Nobody is saying that she should not be allowed to have sex with a stranger, but it is reasonable to say that she should not let herself get herself into dangerous situations. Crossing the street in front of a speeding truck might also help one reaffirm their priorities while spending a few months in traction. If the priority is to die then walking in front of the truck is a great idea.

Watching this episode, I agree. Paul was unkind, cold, and he actually looked almost ill or stressed or something. He was totally uncomfortable.

Watching laura and Alex at the end of this episode makes me think that they're going to have sex, some sort of an affair, something. What would a shrink think about two of their married/engaged (to other people) patients suddenly getting together? It seems kind of dangerous in a way, and yet people have the right to make dangerous choices...

seriously, though, Laura had sex with Alex to be manipulative, not to reaffirm her "priorities."

i hope you will rethink sex with strangers. STD's can cause infertility, a lifetime of painful sores, life threatening pelvic infections, cancer, even death. the after-effects of rape are much greater. you can't pop a pill for that.

Reading your recaps makes me wonder if you know about Television without Pity, and their recaps? Sometimes they're hilarious. (Depending on the writer.) (I don't know if TwoP is covering this show, though, sorry.)

Yeah, my mother told me not to hitch-hike! ;) Since I live in the city I don't have to think about it very often. But if my car has broken down in the country, or if a friend and I are trying to get to a hospital from a suburb in Europe without access to a car of our own, yeah, I hitch-hike. People are pretty nice. We pick up kids hitch-hiking fairly often. They don't have cars but they still have places to go. Kids who live in the country (or even the suburbs) tend to hitch-hike a lot. They're pretty nice too. Hitch-hiking has downsides (inconvenient, unreliable, sometimes the driver is a jerk) but driving your own car is not always an option and has its own downsides (isolating, expensive, hassle of car maintenance).

I don't have sex with strangers these days - I'm partnered, in love and monogamous, and I like it that way. But one can protect oneself quite well against pregnancy and STDs by paying attention (at 43 I have never been pregnant and never had an STD). Most STDs can be treated. And restricting your sexual partners to people you know - even people you live with - even people you are married to - is not guaranteed protection against STDs, rape or murder. (I don't know, but I suspect that the rate of assault and murder by boyfriends/husbands is much higher than that by random hookups. A random hookup's agenda is usually quite simple; and if they are looking for sex with strangers they are not looking for someone to control. Not to say that boyfriends/husbands aren't often a good thing! Just that no choice is without risk, and everyone has to make their own.)

Getting back to people's judgement of Laura: I don't think I've heard anyone get upset with Alex for having sex with Laura. Just Laura for having sex with Alex. (Or thinking about it.)

My tubal ligation still has a 1% failure rate... and condoms don't cover everything. Viral STD's (and there are a lot of them) are not curable, and some bacterial STD's are becoming antibiotic resistant. You are more likely to be killed by your significant other than a complete stranger though.

Laura was manipulating (not to mention engaged), Alex was newly "single" and didn't have hidden motives

Laura and Paul should just get on with the shagging....preferably on the couch in his office, AS SOON AS......they want it and we, the viewers want to see it....there is obviously something between them so go for it!! i say.....she can always find a new psychiatrist!!